Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion
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CLINICAL INVESTIGATION
STROKE/NEUROINTERVENTIONS
Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion Carlos Pin˜ana1,2 • Laura Ludovica Gramegna3,4 • Edgar Folleco2 • Manuel Requena5,2 David Hernandez1,2 • Alejandro Tomasello Weitz1,2
•
Received: 31 January 2020 / Accepted: 4 July 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Introduction Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center. Methods A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d’Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded. Results A total of eight patients were treated with the covered stents, and we observed significant improvement
& Alejandro Tomasello Weitz [email protected] 1
Interventional Neuroradiology Section, Department of Radiology, Vall d0 Hebron University Hospital, Pg. Vall d’Hebron, 119-129, 08035 Barcelona, Spain
2
Vall d0 Hebron Research Institute (VHIR), Vall d0 Hebron University Hospital, Barcelona, Spain
3
IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
4
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
5
Stroke Unit, Department of Neurology, Vall d0 Hebron University Hospital, Barcelona, Spain
in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence. Conclusion The preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS. Keywords Viabahn stent Ischemic stroke Tandem lesions Stenosis Endovascular procedures
Introduction Approximately, 20% of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) present wit
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